Anomalies and Curiosities of Medicine [83]
in a remarkably advanced stage of ossification, with the fontanelles nearly closed. Delivery was effected, though during the passage of the head the pubes separated to such an extent that Eldridge placed two fingers between them. The mother recovered, and had perfect union and normal locomotion.
Sanders reports a case of the separation of the pubic bones in labor. Studley mentions a case of fracture of the pelvis during instrumental delivery. Humphreys cites a most curious instance. The patient, it appears, had a large exostosis on the body of the pubes which, during parturition, was forced through the walls of the uterus and bladder, resulting in death. Kilian reports four cases of death from perforation of the uterus in this manner. Schauta pictures such an exostosis.
Chandler relates an instance in which there was laceration of the liver during parturition; and Hubbard records a case of rupture of the spleen after labor.
Symphysiotomy is an operation consisting of division of the pubic symphysis in order to facilitate delivery in narrow pelves. This operation has undergone a most remarkable revival during the past two years. It originated in a suggestion by Pineau in his work on surgery in 1598, and in 1665 was first performed by La Courvee upon a dead body in order to save the child, and afterward by Plenk, in 1766, for the same purpose. In 1777 Sigault first proposed the operation on the living, and Ferrara was the one to carry out, practically, the proposition,--although Sigault is generally considered to be the first symphysiotormist, and the procedure is very generally known as the "Sigaultean operation." From Ferrara's time to 1858, when the operation had practically died out, it had been performed 85 times, with a recorded mortality of 33 per cent. In 1866 the Italians, under the leadership of Morisani of Naples, revived the operation, and in twenty years had performed it 70 times with a mortality of 24 per cent. Owing to rigid antiseptic technic, the last 38 of these operations (1886 to 1891) showed a mortality of only 50 per cent, while the infant-mortality was only 10 2/3 per cent. The modern history of this operation is quite interesting, and is very completely reviewed by Hirst and Dorland.
In November, 1893, Hirst reported 212 operations since 1887, with a maternal mortality of 12.73 per cent and a fetal mortality of 28 per cent. In his later statistics Morisani gives 55 cases with 2 maternal deaths and 1 infantile death, while Zweifel reports 14 cases from the Leipzig clinic with no maternal death and 2 fetal deaths, 1 from asphyxia and 1 from pneumonia, two days after birth. All the modern statistics are correspondingly encouraging.
Irwin reports a case in which the firm attachment of the fetal head to the uterine parietes rendered delivery without artificial aid impossible, and it was necessary to perform craniotomy. The right temporal region of the child adhered to the internal surface of the neck of the uterus, being connected by membranes. The woman was forty-four years old, and the child was her fourth.
Delay in the Birth of the Second Twin.--In twin pregnancies there is sometimes a delay of many days in the birth of a second child, even to such an extent as to give suspicion of superfetation. Pignot speaks of one twin two months before the other. De Bosch speaks of a delay of seventeen days; and there were 2 cases on record in France in the last century, one of which was delayed ten days, and the other showed an interval of seven weeks between the delivery of the twins. There is an old case on record in which there was an interval of six weeks between deliveries; Jansen gives an account of three births in ten months; Pinart mentions a case with an interval of ten days; Thilenius, one of thirteen days; and Ephemerides, one of one week. Wildberg describes a case in which one twin was born two months after the other, and there was no secretion of milk until after the second birth. A full description of Wildberg's case is given in another journal in brief, as follows: A woman, eighteen
Sanders reports a case of the separation of the pubic bones in labor. Studley mentions a case of fracture of the pelvis during instrumental delivery. Humphreys cites a most curious instance. The patient, it appears, had a large exostosis on the body of the pubes which, during parturition, was forced through the walls of the uterus and bladder, resulting in death. Kilian reports four cases of death from perforation of the uterus in this manner. Schauta pictures such an exostosis.
Chandler relates an instance in which there was laceration of the liver during parturition; and Hubbard records a case of rupture of the spleen after labor.
Symphysiotomy is an operation consisting of division of the pubic symphysis in order to facilitate delivery in narrow pelves. This operation has undergone a most remarkable revival during the past two years. It originated in a suggestion by Pineau in his work on surgery in 1598, and in 1665 was first performed by La Courvee upon a dead body in order to save the child, and afterward by Plenk, in 1766, for the same purpose. In 1777 Sigault first proposed the operation on the living, and Ferrara was the one to carry out, practically, the proposition,--although Sigault is generally considered to be the first symphysiotormist, and the procedure is very generally known as the "Sigaultean operation." From Ferrara's time to 1858, when the operation had practically died out, it had been performed 85 times, with a recorded mortality of 33 per cent. In 1866 the Italians, under the leadership of Morisani of Naples, revived the operation, and in twenty years had performed it 70 times with a mortality of 24 per cent. Owing to rigid antiseptic technic, the last 38 of these operations (1886 to 1891) showed a mortality of only 50 per cent, while the infant-mortality was only 10 2/3 per cent. The modern history of this operation is quite interesting, and is very completely reviewed by Hirst and Dorland.
In November, 1893, Hirst reported 212 operations since 1887, with a maternal mortality of 12.73 per cent and a fetal mortality of 28 per cent. In his later statistics Morisani gives 55 cases with 2 maternal deaths and 1 infantile death, while Zweifel reports 14 cases from the Leipzig clinic with no maternal death and 2 fetal deaths, 1 from asphyxia and 1 from pneumonia, two days after birth. All the modern statistics are correspondingly encouraging.
Irwin reports a case in which the firm attachment of the fetal head to the uterine parietes rendered delivery without artificial aid impossible, and it was necessary to perform craniotomy. The right temporal region of the child adhered to the internal surface of the neck of the uterus, being connected by membranes. The woman was forty-four years old, and the child was her fourth.
Delay in the Birth of the Second Twin.--In twin pregnancies there is sometimes a delay of many days in the birth of a second child, even to such an extent as to give suspicion of superfetation. Pignot speaks of one twin two months before the other. De Bosch speaks of a delay of seventeen days; and there were 2 cases on record in France in the last century, one of which was delayed ten days, and the other showed an interval of seven weeks between the delivery of the twins. There is an old case on record in which there was an interval of six weeks between deliveries; Jansen gives an account of three births in ten months; Pinart mentions a case with an interval of ten days; Thilenius, one of thirteen days; and Ephemerides, one of one week. Wildberg describes a case in which one twin was born two months after the other, and there was no secretion of milk until after the second birth. A full description of Wildberg's case is given in another journal in brief, as follows: A woman, eighteen